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Cited by 14Healthcare Decision-Making and RestraintsPalliative Care and End-of-Life IssuesEthics and bioethics in healthcare

Assessment of capacity to give informed consent for medical assistance in dying: a qualitative study of clinicians’ experience

Open access
Wiebe, Ellen, Kelly, Michaela, McMorrow, Thomas, Tremblay-Huet, Sabrina, Hennawy, Mirna·2021·CMAJ Open
DOI 10.9778/cmajo.20200136PMC PMC8084565
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Abstract

BACKGROUND: , medical assistance in dying (MAiD) requires that patients give informed consent and that their ability to consent is assessed by 2 clinicians. In this study, we intended to understand how Canadian clinicians assessed capacity in people requesting MAiD. METHODS: This qualitative study used interviews conducted between August 2019 and February 2020, by phone, video and email, to explore how clinicians assessed capacity in people requesting MAiD, what challenges they had encountered and what tools they used. The participants were recruited from provider mailing listserves of the Canadian Association of MAiD Assessors and Providers and Aide médicale à mourir. Interviews were audio-recorded and transcribed verbatim. The research team met to review transcripts and explore themes as they emerged in an iterative manner. We used abductive reasoning for thematic analysis and coding, and continued to discuss until we reached consensus. RESULTS: The 20 participants worked in 5 of 10 provinces across Canada, represented different specialties and had experience assessing a total of 2410 patients requesting MAiD. The main theme was that, for most assessments, the participants used the conversation about how the patient had come to choose MAiD to get the information they needed. When the participants used formal capacity assessment tools, this was mostly for meticulous documentation, and they rarely asked for psychiatric consults. The participants described how they approached assessing cases of nonverbal patients and other challenging cases, using techniques such as ensuring a quiet environment and adequate hearing aids, and using questions requiring only "yes" or "no" as an answer. INTERPRETATION: The participants were comfortable doing MAiD assessments and used their clinical judgment and experience to assess capacity in ways similar to other clinical practices. The findings of this study suggest that experienced MAiD assessors do not routinely require formal capacity assessments or tools to assess capacity in patients requesting MAiD.

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  • While standardized tests for mental capacity exist, studies suggest clinicians rarely use formal assessments in clinical practice.

    “While standardized tests for mental capacity exist, studies suggest clinicians rarely use formal assessments in clinical practice (45, 46).”

    From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [46]

    The Introduction (page not provided) names validated capacity-assessment tools, and the Conclusion says experienced assessors did not routinely use formal tools for patients requesting medical assistance in dying. The study concerns 20 MAiD assessors, so it does not establish that clinicians generally rarely use formal assessments across clinical practice. (LLM, conf=0.88)

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Research works printed but not linked: 1

  1. [2]Chapter S-32.0001: Act respecting end-of-life care. Québec: Les Publications du Québec; updated 2020 June 1.

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Authors
Wiebe, E., Kelly, M., McMorrow, T., Tremblay-Huet, S., & Hennawy, M.
Affiliations
University of London (GB)
Corresponding author
Wiebe, Ellen
ORCID
Venue
CMAJ Open
Publisher
CMA Impact Inc.
Published
2021-04
Volume
9
Issue
2
Pages
E358-E363
ISSN
2291-0026 (ISSN-L)
DOI
10.9778/cmajo.20200136
PMC
PMC8084565
OpenAlex
W3152814682
Cited by
14
References
19
Citations by year
2026: 2 · 2025: 5 · 2024: 3 · 2023: 4
FWCI
1.19
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • CMAJ Open (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
Keywords
medical assistance in dying, informed consent, capacity assessment, clinician experience, nonverbal patients, clinical judgment, end-of-life care, psychiatric consultation
MeSH terms
Clinical Decision-Making, Attitude of Health Personnel, Canada, Humans, Informed Consent, Nurses, Practice Patterns, Physicians', Physicians, Professional Practice, Right to Die, Social Control, Formal, Mental Competency, Suicide, Assisted, Guidelines as Topic, Codes of Ethics, Euthanasia, Active, Voluntary, Qualitative Research

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